Provider First Line Business Practice Location Address:
1826 WEST SEVEN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90057
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-484-6660
Provider Business Practice Location Address Fax Number:
213-484-8001
Provider Enumeration Date:
08/30/2006